Adams Jared R, Elting Linda S, Lyman Gary H, George James N, Lembersky Barry C, Armitage James O, Demetri George D, Bennett Charles L
Department of Veterans Affairs, the MidWest Center for Health Services and Policy Research and the Veterans Affairs Chicago Healthcare System/Lakeside Division, Chicago, Illinois, USA.
Am J Med. 2004 Jan 1;116(1):28-34. doi: 10.1016/j.amjmed.2003.06.004.
To assess physician use of erythropoietin in cancer patients before publication of the American Society of Clinical Oncology/American Society of Hematology guidelines.
Questionnaires about erythropoietin use in practice and 12 hypothetical clinical scenarios involving patients with cancer were mailed to 2000 oncologists/hematologists in the United States and 19 other countries. Response rates were 30% in the United States and 25% internationally. Data on erythropoietin use for ovarian cancer were obtained from one clinical trial. Multivariate regression models assessed predictors of erythropoietin prescription.
Most physicians selected a hemoglobin level < or =10 g/dL as an upper threshold for erythropoietin use (36% to 51% of U.S. physicians and 21% to 32% of foreign physicians). Frequent erythropoietin use (defined as use in at least 10% of cancer patients) was higher in the United States than elsewhere (adjusted odds ratio [OR] = 5.8; 95% confidence interval [CI]: 2.5 to 13.4). Among U.S. physicians, those who said they used erythropoietin frequently were more likely to be in fee-for-service than managed care settings (OR = 2.2; 95% CI: 1.3 to 3.7). Those who reported never using erythropoietin practiced in countries that had lower annual per capita health care expenditures, lower proportions of privately funded health care, and a national health service (P <0.05 for all comparisons). Of 235 ovarian cancer patients who received topotecan, 38% (45/118) of U.S. patients and 2% (2/117) of European patients who developed grade 1 anemia (hemoglobin level between 10 and 12 g/dL) were treated with erythropoietin (P <0.01).
Financial considerations and a hemoglobin level <10 g/dL appear to influence erythropoietin use in the United States, whereas financial considerations alone determine erythropoietin use abroad.
在美国临床肿瘤学会/美国血液学会发布指南之前，评估医生在癌症患者中使用促红细胞生成素的情况。
关于促红细胞生成素在实际应用中的调查问卷以及12个涉及癌症患者的假设临床病例被邮寄给美国和其他19个国家的2000名肿瘤学家/血液学家。美国的回复率为30%，国际上的回复率为25%。卵巢癌促红细胞生成素使用的数据来自一项临床试验。多变量回归模型评估促红细胞生成素处方的预测因素。
大多数医生选择血红蛋白水平≤10 g/dL作为促红细胞生成素使用的上限阈值（36%至51%的美国医生以及21%至32%的外国医生）。美国促红细胞生成素的频繁使用（定义为至少10%的癌症患者使用）高于其他地区（校正比值比[OR]=5.8；95%置信区间[CI]：2.5至13.4）。在美国医生中，那些表示频繁使用促红细胞生成素的医生在按服务收费的环境中比在管理式医疗环境中更常见（OR=2.2；95%CI：1.3至3.7）。那些报告从未使用促红细胞生成素的医生所在国家的人均年度医疗保健支出较低、私人资助医疗保健的比例较低且有国家医疗服务体系（所有比较P<0.05）。在接受拓扑替康治疗的235例卵巢癌患者中，出现1级贫血（血红蛋白水平在10至12 g/dL之间）的美国患者中有38%（45/118）接受了促红细胞生成素治疗，欧洲患者中有2%（2/117）接受了促红细胞生成素治疗（P<0.01）。
在美国，经济因素和血红蛋白水平<10 g/dL似乎会影响促红细胞生成素的使用，而在国外，仅经济因素决定促红细胞生成素的使用。
